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. 2019 Sep;186(6):900-907.
doi: 10.1111/bjh.16003. Epub 2019 Jun 5.

Rapid decline in estimated glomerular filtration rate is common in adults with sickle cell disease and associated with increased mortality

Vimal K Derebail  1 , Qingning Zhou  2 , Emily J Ciccone  3 , Jianwen Cai  4 , Kenneth I Ataga  5
Affiliations

Rapid decline in estimated glomerular filtration rate is common in adults with sickle cell disease and associated with increased mortality

Vimal K Derebail et al. Br J Haematol. 2019 Sep.

Abstract

We evaluated the prevalence of rapid decline in kidney function, its potential risk factors and influence upon mortality in sickle cell disease (SCD) in a retrospective single-center study. Rapid decline of kidney function was defined as estimated glomerular filtration rate (eGFR) loss of >3·0 ml/min/1·73 m2 per year. A multivariable logistic regression model for rapid eGFR decline was constructed after evaluating individual covariates. We constructed multivariate Cox-regression models for rapid eGFR decline and mortality. Among 331 SCD patients (median age 29 years [interquartile range, IQR: 20, 41]; 187 [56·5%] female) followed for median 4·01 years (IQR: 1·66, 7·19), rapid eGFR decline was noted in 103 (31·1%). History of stroke (odds ratio [OR]: 2·91, 95% confidence interval [CI]: 1·25-6·77) and use of angiotensin converting enzyme inhibitors/angiotensin receptor blockers (OR: 3·17, 95% CI: 1·28-7·84) were associated with rapid eGFR decline. The rate of eGFR change over time was associated with mortality (hazard ratio [HR]: 0·99, 95% CI: 0·984-0·995, P = 0·0002). In Cox-regression, rapid eGFR decline associated with mortality (HR: 2·07, 95% CI: 1·039-4·138, P = 0·04) adjusting for age, sex and history of stroke. Rapid eGFR decline is common in SCD and associated with increased mortality. Long-term studies are needed to determine whether attenuating loss of kidney function may decrease mortality in SCD.

Keywords: chronic kidney disease; glomerular filtration; kidney function; sickle cell disease.

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Conflict of interest statement

Conflict of interest: The authors declare that there are no conflicts of interest.

Figures

Figure 1:
Figure 1:
Kaplan-Meier Estimates of the Survival Probabilities for Rapid and Non-Rapid Estimated Glomerular Filtration Rate (eGFR) Decline Groups.
See this image and copyright information in PMC

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